Infection Flashcards
Chalmydia:
when to test? (1)
management (1)
management in pregnancy (1)
2 weeks post exposure
doxycycline (7 day course) if first-line
if pregnant then azithromycin, erythromycin or amoxicillin
When to send urine culture in LRTI:
certain groups (3)
certain finding on dip (1)
age >65
pregnancy (all cases)
men (all cases)
haematuria (visible or non visible)
What UTI med to avoid in pregnancy?
trimethoprim
avoid Nitro FINAL TERM but okay at start
asymptomatic bacteriuria in pregnant women?
treat 7/7 nitrofurantoin (unless end term)
man and UTI; do you refer to urology?
‘Referral to urology is not routinely required for men who have had one uncomplicated lower urinary tract infection (UTI).’
when to treat UTI in catheterised
is symptomatic 7/7 + consider chaining catheter
acute pyelonephritis management
the BNF currently recommends a broad-spectrum cephalosporin or a quinolone (for non-pregnant women) for 10-14 days
Pneumococcal vaccine (only offered one off as it does not mutate as fast as influenza). Who is it offered to?
all >65 years AND those with:
- asplenia or splenic dysfunction
- chronic respiratory disease: COPD, bronchiectasis, cystic fibrosis, interstitial lung disease. Asthma is only included if ‘it requires the use of oral steroids at a dose sufficient to act as a significant immunosuppressant’
- chronic heart disease: ischaemic heart disease if requiring medication or follow-up, heart failure, congenital heart disease. Controlled hypertension is not an indication for vaccination
- chronic kidney disease (at stages 4 and 5, nephrotic syndrome, kidney transplantation)
- chronic liver disease: including cirrhosis and chronic hepatitis
- diabetes mellitus if requiring medication
immunosuppression (either due to disease or treatment). This includes patients with any stage of HIV infection
- cochlear implants
- patients with cerebrospinal fluid leaks
Influenza vaccine who is it offered to?
The Department of Health recommends annual influenza vaccination for people older than 65 years and those with:
chronic respiratory disease (including asthmatics who use inhaled steroids)
chronic heart disease (heart failure, ischaemic heart disease, including hypertension if associated with cardiac complications)
chronic kidney disease (at stages 3, 4 or 5, chronic kidney failure, nephrotic syndrome, kidney transplantation)
chronic liver disease: cirrhosis, biliary atresia, chronic hepatitis
chronic neurological disease: (e.g. Stroke/TIAs)
diabetes mellitus (including diet controlled)
immunosuppression due to disease or treatment (e.g. HIV)
asplenia or splenic dysfunction
pregnant women
Other at risk individuals include:
health and social care staff directly involved in patient care (e.g. NHS staff)
those living in long-stay residential care homes
carers of the elderly or disabled person whose welfare may be at risk if the carer becomes ill (at the GP’s discretion)
When to avoid an LP?
signs of severe sepsis or a rapidly evolving rash
severe respiratory/cardiac compromise
significant bleeding risk
signs of raised intracranial pressure
focal neurological signs
papilloedema
continuous or uncontrolled seizures
GCS ≤ 12
important organism causing LRTI in cystic fibrosis patients
Pseudomonas aeruginosa
Pseudomonas aeruginosa: what does it cause?
what type of bacteria? (1)
Gram -ve rod
chest infections (especially in cystic fibrosis)
skin: burns, wound infections, ‘hot tub’ folliculitis
otitis externa (especially in diabetics who may develop malignant otitis externa)
urinary tract infections
produces both an endotoxin (causes fever and shock) and exotoxin A (inhibits protein synthesis by catalyzing ADP-ribosylation of elongation factor EF-2)
Meningitis management:
<3 months
3 months - 50 years
>50 years
Initial empirical therapy aged < 3 months –> IV cefotaxime + amoxicillin (or ampicillin)
Initial empirical therapy aged 3 months - 50 years –> IV cefotaxime (or ceftriaxone)
Initial empirical therapy aged > 50 years IV cefotaxime (or ceftriaxone) + amoxicillin (or ampicillin)
Other causes menigitis management
meningococcal
pneumococal
haemopgilus influenza
listeria
Meningococcal meningitis IV benzylpenicillin or cefotaxime (or ceftriaxone)
Pneumococcal meningitis IV cefotaxime (or ceftriaxone)
Meningitis caused by Haemophilus influenzae IV cefotaxime (or ceftriaxone)
Meningitis caused by Listeria IV amoxicillin (or ampicillin) + gentamicin
management of meningitis contacts
Prophylaxis to ALL households and close contacts of patients affected with meningococcal meningitis.
Prophylaxis should also be offered to people who have been exposed to respiratory secretion, regardless of the closeness of contact. The risk to contacts is highest in the first 7 days but persists for at least 4 weeks.
CIPROFLOXACIN or RIFAMPICIN
meningococcal vaccination should be offered to close contacts when serotype results are available, including booster doses to those who had the vaccine in infancy
for pneumococcal meningitis, no prophylaxis is generally needed. There are however exceptions to this. If a cluster of cases of pneumococcal meningitis occurs the HPA have a protocol for offering close contacts antibiotic prophylaxis. Please see the link for more details
TB: latent disease
treatment options (2)
3 months of isoniazid (with pyridoxine) and rifampicin, or
6 months of isoniazid (with pyridoxine)
Risk factors developing ative TB from latent?
silicosis
chronic renal failure
HIV positive
solid organ transplantation with immunosuppression
intravenous drug use
haematological malignancy
anti-TNF treatment
previous gastrectomy
Latent TB: can it spread
NO
vaginal discharge: offensive, yellow/green, frothy
vulvovaginitis
strawberry cervix
pH > 4.5
in men is usually asymptomatic but may cause urethritis
Trichomonas vaginalis
presents v similar to BV but BV is white thin discharge with CLUE cells
Trichomonas vaginalis treatment?
oral metronidazole 5-7 days
Wet mount: BV vs trichomonas
BV= clue cells
Trichoomonas: motile trophozoites
Tic bite:
diagnosis? (2)
can be clinical if erythema migraines present
OR ELISA antibodies to Borrelia burgdoferi
Tic bite:
what to do?
pull it out
no need for further investigations if asymptomatic
Lyme disease:
treatment (1)
doxycycline in early disease
or amoxicillin if I pregnancy
Lyme disease:
Sx
erythema migrans
‘bulls-eye’ rash is typically at the site of the tick bite
typically develops 1-4 weeks after the initial bite but may present sooner
usually painless, more than 5 cm in diameter and slowlly increases in size
present in around 80% of patients.
systemic features
headache
lethargy
fever
arthralgia
A 78-year-old nursing home resident with a long term catheter presents to general practice with a positive urine culture. This reveals an E coli sensitive to amoxicillin, trimethoprim and nitrofurantoin. He is otherwise well and denies any dysuria.
no Abx needed
Genital wart:
treatment 1st line for multiple (1) and solitary (1)
2nd line (1)
1st LINE=
multiple, non-keratinised warts: topical podophyllum
solitary, keratinised warts: cryotherapy
2nd LINE=
imiquimod is a topical cream
dapagliflozin, which is an SGLT-2 inhibitor, + perineum risk
nectrotizing fasciitis
Necrotising fasciitis on there perineum - also called…
Fourniers gangrene
Bacterial vaginosis in pregnancy management
oral metronidazole 5-7 days
Bacterial vaginosis management If asymptomatic
no treatment (unless undergoing termination)
BV treatment
oral metronidazole 5-7 days
HPV vaccination
All 12- and 13-year-olds (girls AND boys) x 1 DOSE ONLY
HIV exposure (e.g. needle tick):
when to start (1)
how long for? (1)
when to re-test? (1)
a combination of oral antiretrovirals (e.g. Tenofovir, emtricitabine, lopinavir and ritonavir) as soon as possible (i.e. Within 1-2 hours, but may be started up to 72 hours following exposure) for 4 weeks
serological testing at 12 weeks following completion of post-exposure prophylaxis
Infectious mononucleosis:
which virus?
triad of Sx? (3)
Other feautres?
EBV
The classic triad of sore throat, pyrexia and lymphadenopathy is seen in around 98% of patients:
sore throat
lymphadenopathy: may be present in the anterior and posterior triangles of the neck, in contrast to tonsillitis which typically only results in the upper anterior cervical chain being enlarged
pyrexia
Other:
malaise, anorexia, headache
palatal petechiae
splenomegaly - occurs in around 50% of patients and may rarely predispose to splenic rupture
hepatitis, transient rise in ALT
lymphocytosis: presence of 50% lymphocytes with at least 10% atypical lymphocytes
haemolytic anaemia secondary to cold agglutins (IgM)
a maculopapular, pruritic rash develops in around 99% of patients who take ampicillin/amoxicillin whilst they have infectious mononucleosis
How long does infectious mononucleosis last?
test for it?
2-4 wekes
Monostop test
EBV: (infectious mononucleosis)
management?
rest + conservative
avoid contact sports for 4 weeks (reduce splenic rupture)
Allergy to metronidazole with BV?
clindamycin
Spinal abscess: what scan to do?
MRI whole spine (check for skip lesions)
Erythema chronicum migrans - what caused by?
LYME disease can be thought of like a wave spreading when you drop a pebble in a pond - erythema migrans
Tetanus: when to repeat?
If a patient has had 5 doses of tetanus vaccine, with the last dose < 10 years ago, they don’t require a booster vaccine nor immunoglobulins, regardless of how severe the wound is
MRSA carrier: what to do?
where to treat? (2)
nose: mupirocin 2% in white soft paraffin, tds for 5 days
skin: chlorhexidine gluconate, od for 5 days. Apply all over but particularly to the axilla, groin and perineum
Abx for MSRA (3)
vancomycin
teicoplanin
linezolid
Bacterial vaginosis - overgrowth of predominately of….
Gardnerella vaginalis
